Heart failure in advanced chronic kidney disease: treatment rationale

Herzinsuffizienz bei fortgeschrittener Niereninsuffizienz: Grundprinzip der Behandlung

Abstract

Patients with chronic kidney disease (CKD) exhibit an increased risk to develop heart failure and the presence of heart failure in patients with CKD leads to a worse prognosis. The following overview article summarizes the current standard of medical heart failure therapy and discusses the treatment characteristics in patients with CKD.

Zusammenfassung

Patienten mit chronischer Niereninsuffizienz weisen ein erhöhtes Risiko auf, eine Herzinsuffizienz zu entwickeln, und das Vorliegen einer Herzinsuffizienz bei Patienten mit chronischer Niereninsuffizienz führt zur Verschlechterung der Prognose. In der vorliegenden Übersichtsarbeit wird der derzeitige Standard der medizinischen Therapie bei Herzinsuffizienz zusammengefasst dargestellt. Außerdem werden die Charakteristika der Behandlung von Patienten mit chronischer Niereninsuffizienz erörtert.

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References

  1. 1.

    Anonymous (1999) The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomised trial. Lancet 353:9–13

    Article  Google Scholar 

  2. 2.

    Anonymous (1999) Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT-HF). Lancet 353:2001–2007

    Article  Google Scholar 

  3. 3.

    Badve SV, Roberts MA, Hawley CM et al (2011) Effects of beta-adrenergic antagonists in patients with chronic kidney disease: a systematic review and meta-analysis. J Am Coll Cardiol 58:1152–1161

    CAS  Article  Google Scholar 

  4. 4.

    Heerspink HJL, Stefánsson BV, Correa-Rotter R et al (2020) Dapagliflozin in patients with chronic kidney disease. N Engl J Med 383:1436–1446

    CAS  Article  Google Scholar 

  5. 5.

    House AA (2018) Management of heart failure in advancing CKD: core curriculum 2018. Am J Kidney Dis 72:284–295

    Article  Google Scholar 

  6. 6.

    Mcmurray JJ, Packer M, Desai AS et al (2014) Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371:993–1004

    Article  Google Scholar 

  7. 7.

    Mcmurray JJV, Solomon SD, Inzucchi SE et al (2019) Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 381:1995–2008

    CAS  Article  Google Scholar 

  8. 8.

    Packer M, Anker SD, Butler J et al (2020) Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 383(15):1413–1424. https://doi.org/10.1056/NEJMoa2022190

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Packer M, Bristow MR, Cohn JN et al (1996) The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. carvedilol heart failure study group. N Engl J Med 334:1349–1355

    CAS  Article  Google Scholar 

  10. 10.

    Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European society of cardiology (ESC). Developed with the special contribution of the heart failure association (HFA) of the ESC. Eur J Heart Fail 18:891–975

    Article  Google Scholar 

  11. 11.

    Zannad F, Mcmurray JJ, Krum H et al (2011) Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 364:11–21

    CAS  Article  Google Scholar 

  12. 12.

    Arrigo M, Cippà PE, Mebazaa A (2018) Cardiorenal interactions revisited: how to improve heart failure outcomes in patients with chronic kidney disease. Curr Heart Fail Rep 15(5):307–314

    CAS  Article  Google Scholar 

Download references

Acknowledgements

NM and JF are supported by the Deutsche Forschungsgemeinschaft (German Research Foundation; TRR 219; Project-ID 322900939 [C01, M01, M03, M05]).

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Correspondence to Prof. N. Marx MD, FESC, FAHA.

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Conflict of interest

N. Marx has received support for clinical trial leadership from Boehringer Ingelheim, Novo Nordisk, served as a consultant to Boehringer Ingelheim, Merck, Novo Nordisk, AstraZeneca, BMS, received grant support from Boehringer Ingelheim, Merck, Novo Nordisk, and served as a speaker for Boehringer Ingelheim, Merck, Novo Nordisk, Lilly, BMS, and Astra Zeneca. N. Marx declines all personal compensation from pharma or device companies. J. Floege served as a consultant to Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, and Novo Nordisk.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Marx, N., Floege, J. Heart failure in advanced chronic kidney disease: treatment rationale. Herz (2021). https://doi.org/10.1007/s00059-021-05024-3

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Keywords

  • Renal insufficiency, chronic
  • Angiotensin-converting enzyme inhibitors
  • Beta-blockers
  • Angiotensin receptor-neprilysin inhibitor
  • SGLT2 inhibitors

Schlüsselwörter

  • Chronische Niereninsuffizienz
  • Angiotensin-Converting-Enzym-Hemmer
  • Betablocker
  • Angiotensin-Rezeptor-Neprilysin-Inhibitor
  • SGLT2-Inhibitoren